Prework Survey Form Notify Prework Survey FormNameDateAddressDescription of WorksWorking at height required? Yes No NADetailsSite AccessAre building security measures employed? Yes No NAcommentsSigning in to gain access? Yes No NAAdditional informationIs there an induction? Yes No NACommentsPermits to work required? Yes No NACommentsVechicle parking? Yes No NACommentsMEWP parking? Yes No NAAdditional InformationBuilding / LocationEmergency Response PlanTraffic consideration? Yes No NAAdditional informationOther activities? (busy road/school/public etc) Yes No NAAdditional informationNotable building design (possible restrictions) Yes No NAAdditional informationWindow frames structurally sound? Yes No NAAdditional informationWiring /overhead cables? Yes No NAAdditional informationRoof InformationRoof access Yes No NACommentsFragile roof Yes No NAAdditional InformationPooling rain water? Yes No NAAdditional InformationAbrasive edges? Yes No NAAdditional InformationSky lights? Yes No NAAdditional InformationLoose objects stored at height? (risk of falling) Yes No NAAdditional InformationAnchor points in relation to work taking place Yes No NAAdditional InformationStructural integrity of anchor points (mansafe certificates) Yes No NAAdditional InformationCOSHH / PPE RequiredAre substances hazardous to heath being used? Yes No NAAdditional InformationIssue relevant COSHH Assessment? Yes No NAAdditional InformationPPE required Yes No NAAdditional InformationWelfare FacilitiesWelfare Facilities available? Yes No NAAdditional InformationEnvironmental Factors to considerIs there any wildlife in close proximity? Yes No NAAdditional InformationBiological hazards (bird faeces) Yes No NAAdditional InformationOther ConsiderationsGround conditions/load bearing capacity Yes No NAAdditional InformationWorking over /near water? Yes No NAAdditional InformationPotential slips, trips or falls? Yes No NAAdditional InformationSubmit Form
